Bleary-eyed, you slowly have a little stretch, pull away the duvet and swing your legs off the bed. It's early, the alarm has just gone off and you could do with another hour of sleep but, never mind, you're awake now. You stand up and immediately a searing pain bursts to life through your heel. The kind of pain like standing on a Lego brick, a three pin plug. The kind of pain that could cause you to tear the nipples off a koala, if only it would give you some relief.
I know this because I've been there.
Lots of people I know suffer with heel pain and, although it can really hurt, they just get on with life. The problem with this, though, is that pain is our body's way of telling us that something is wrong. Chronic pain - pain which lasts for over 3 months can also have a detrimental effect on our mental well-being and physiology. The increase in stress hormones can lead to fat gain, due to the way chemicals are working in our cells; added to this is the possibility of muscle imbalances as we adapt the way we move to mitigate the heel pain, which, in turn, leads to pain in other joints (including back pain from the spinal muscles). You're then left in a cycle of adaptation to different areas of pain through the body. It's like papering over a crack in a wall - you can't see the crack anymore but it's still there. Over time the crack will get bigger and lead to more cracks, which leads to more papering until it all crumbles.
So, what can we do? First off we have to look at what might be causing the pain; there are a few common injuries.
Plantar Fasciitis and Heel Spurs
A sharp pain in the bottom of the heel that is uncomfortable to walk on . It can be worse first thing in the morning, due to the tissues being dormant.
The plantar fascia runs from the heel and under the foot. Although not a muscle, it's a band of tissue that works with other muscles in movement during running and walking.
Other muscles becoming tight can affect this and cause pain at the site of attachment. This can lead to thickening and stiffening of the plantar fascia, increasing the pain.
It's designed to stretch and recoil as we move, a bit like if you attached a rubber band to each end of a bendy ruler.
So, what causes it?...
Well, everything that causes it is down to you. Being overweight can be a factor, along with ill fitting footwear (you the pair of shoes that are really worn down on the corner of the heel... but they're so comfy that you don't want to part with them), over-pronation (your ankle and foot aren't in alignment. This is usually the result of imbalances elsewhere, leading to the same cause and effect cycle as heel pain) but, most probably is down to tightness in the calf. Muscles that do so much work every day get shortened, which pulls on the heel bone, which in turn affect the plantar fascia.
A heel spur is a build up of calcium deposits on the underside of the heel. Usually not a problem and spurs can occur all around the body. Unfortunately they can cause problems with the plantar fascia and lead to pain. The only way to get rid of a heel spur is by surgery but don't go rushing to the doctors yet!
Pain when running, walking or jumping at the back or top of your heel? Small, fluid filled sacs, called a bursa, are placed at joints to aid the tendon to move over bone without abrasion. When there's over-use leading to tightness, this can cause the tendon to wear on the bursa. Prolonged bursitis can lead to a rupture, affecting the Achilles tendon and increasing risk of more damage, the possibility of a spur growth and increased pain.
Along with tightness in the calf, the wearing of shoes that are too tight, being overweight and the way you walk and run are all aggravating factors.
If you have a bursitis, as well as pain you may also see swelling and redness.
Also known as Baxter's Nerve, there are very similar symptoms to plantar fasciitis. The difference being that there will likely be more pain towards the end of the day. It's common in sprinters, ballet dancers and those who spend a lot of time on their toes. Again, like plantar fasciitis, tightness in the calf, over-pronation and being overweight can be contributing factors, as well as overworking the arch of the foot. This is where the the gets pinched as it comes around the foot and is trapped by contracting muscles.
Heel Fat Pad Syndrome
The sensation of tenderness, bruising and inflammation around the middle bottom of the heel. There are a couple of things that can affect this. Under the heel bone, there's a mass of tissue. It's there to protect the bone from impact. Repeated impact can cause membranes to rupture and less protection to nerve endings between the skin and heel bone. This can be remedied; unfortunately, other factors that can cause this include age and obesity. Where these are the reasons, it's because the tissue has diminished, or atrophied, and tends to be irreversible without some kind of surgery. There are still things that can help, though.
WHAT THE BLOODY HELL CAN I DO THEN?!!!!
Ice. Icing the affected area will reduce swelling and and pressure. Without putting the ice directly onto the site of pain (use a cloth or a towel - this will stop the skin and underlying tissue getting a cold burn). The area doesn't need to go numb. The purpose of icing is to restrict the blood vessels supplying the damaged area. You only need to ice for a maximum of 10-15 minutes. After that, the body will adapt and it will no longer be effective. Once the affected area has returned to normal, you can ice again.
Massage. That's right, massage and we're not talking about the kind that has smutty overtones. Go and see a good quality, sports massage therapist, like myself. Releasing tension in the calf will help with plantar fasciitis. Then there's releasing the plantar fascia, under your foot arch and the muscles that maintain that arch. If you think it's beyond your financial means or that you don't need to pay a professional to help remove your pain there is also self massage. You can use a small ball - anything from a golf ball, tennis ball, lacrosse ball... even a hockey ball will have an effect. The size and hardness will change how painful the massage is and it's effectiveness. Get it under your foot and roll in strokes, length-ways. If you can't get hold of a ball, you can use a small bottle. Make sure it's water tight and has something in it, though. For a double-whammy, stick it in the freezer or fridge for a bit. For your calf, you use a ball or even an old roll-on. Just apply some pressure and move from bottom to top.
Stretching through the calf and bottom of the foot will also help to lengthen the tissues holding tension. This will put less stress through the ankle joint and the underside of the foot. Stand facing a wall with the affected foot pressed back, heel to the ground at the point you feel the top of the calf stretch. Hold for 30-40 seconds, increasing the stretch as you feel it ease off.
There are also ways to strengthen the arch of the foot. Either by sitting in a chair, using a towel laid flat on the floor and scrunching it towards you using your toes or by having some pens set out on the floor and then squeezing your toes towards your heel and trying to lift them up one at a time. Going barefoot as much as possible will help to strengthen and stretch out tendons and muscles. If you're regularly going barefoot and still have problems... it's probably not the solution for you. Strengthening the calf by doing gentle heel raises can help where there may be a bursitis or a rupture. Pressing up into a tip-toe and then concentrating on the movement and slowly squeezing up just a little more will help to strengthen the plantar fascia and also your calf muscle.
Where there is no option for massage, stretching or strengthening - such as with age related heel pad syndrome - then there are products to help with support. Now, I'm not an advocate for long term supports to fix an injury as it really just masks a problem. It's a bit like sticking a temporary support under a damaged road bridge. You can probably get traffic over there but the bridge is still knackered. Remove the support and the bridge collapses. Fix the damage and you've got a good bridge. Not the best analogy... but an analogy, all the same. With heel pad syndrome my ideas differ slightly as it's the next best thing to surgery for those that need it. If rest hasn't helped then the heel can be taped to hold it all together. Again, with this, you're going to need a professional or you can look at videos on YouTube and have a go yourself. From experience some methods of taping are difficult to do on yourself, depending on your range of movement and flexibility. You could also search for cushioned, orthotic insoles. Foot Active and Orthosole are two good, off the shelf brands that I've used in military boots. That's carrying weight on my back and walking for miles. There are plenty of other brands out there and I will be trialling another brand. I'll update the blog to include them if I think they're worth promoting. There are specialist socks out there. too, but if you have got the funds it is well worth investing in a good podiatrist who make custom orthotics. I did this many years ago when I had plantar fasciitis and didn't have the knowledge or skills to help myself. I had custom orthotics made and they helped me through a tour of Afghanistan. Be aware, though, customs don't come cheap and I think I paid £300 for them. Look at your footwear - if the sole is worn down in a particular way, or you're wearing high heels a lot, or there is no support it can cause you some major grief. Even going barefoot when you have fat pad syndrome will cause discomfort and possibly worsen the situation. A professional eye and opinion on your problem might be beneficial, though, and either a podiatrist, physiotherapist or a good personal trainer and massage therapist would be able to see if your heel pain is caused by another part of your body.
All of this advice is all well and good but if you suspect you might have a fracture, I fully recommend you get yourself to your doctor or down to A&E.
If you've read this and still have questions or are unsure about anything, ping me an email or send a question through Facebook or Twitter and I'll do my damnedest to help.
Thanks for reading and hopefully you can now do something to help yourself. Download or print off the infographic and you've a handy crib card.